Continuous Sub-Q Insulin Infusion in Diabetes Management

The desirability of close glucose control, highlighted by the Diabetes Control and Complications Trial (DCCT), led many diabetics to undertake multiple daily injections (MDI) to improve their diabetes management. But for some, this meant a heightened risk of hypoglycemic episodes. Insulin pumps had been available for some time and they now offered a possible means of achieving heightened glucose control without such a high risk of hypoglycemia through Continuous Subcutaneous Insulin Infusion (CSII).

In fact, Bode and Steed (Bode BW & Steed RD [1996], Reduction in Severe Hypoglycemia with Long-term CSII in Type I Diabetes. Diabetes Care 1996: 324–327) studied patients who had been using MDI and who had experienced recurrent hypoglycemia, and hypoglycemic unawareness. These patients transferred to CSII. The incidence of severe hypoglycemia declined more than six-fold during the first year of CSII, and remained significantly lower in years two, three and four on CSII. The frequency of diabetic ketoacidosis also declined with CSII from 14.6% to 7.2%. The average daily insulin dose one year after initiation was 15% lower than the MDI dosage. In this study, “patients maintained an excellent level of glycemic control, and achieved a significant reduction in the rate of severe hypoglycemia relative to pre-study management with MDI.” CSII therefore becomes the prime mechanism when there is a clear failure of MDI.

Due to innovation and increased acceptance, the global market for insulin pump and related disposables is growing in the double-digits, led by such companies as Roche Insulin Delivery Systems (formerly Disetronic) and Medtronic’s MiniMed, which together hold the lion’s share of the market. A range of innovations continues to emerge from these manufacturers and others to improve the ease of use, the level of glucose control and the overall quality of life for diabetics.

[Shown is Insulet’s OmniPod®, which is a tubeless pump via its direct contact to the patient’s skin, with infusion provided through a subcutaneous cannula.]